Child's Name ______________________________________________________________________________________________

Age _____________________ Date of Birth __________________________________________

Parent's Name ___________________________________________________________________________________________

Telephone # HOME__________________________________CELL___________________________________________

Address___________________________________________________________________________________________ street city zip

(initial one) ______________ Yes ______________ No

CLASS REGISTERING FOR ______________________________________________________________________________________

Preferred Payment Arrangement:

__________by check monthly     __________  cash monthly       __________ by semester 

Although we take every precaution feasible and use all the T.L.C. possible, Brown's Gymnastics and the hosting location are not responsible for any injury occurring as a result of regular class participation. Because of its nature, a few bumps and tumbles can be expected.   I understand all policies and give my permission for my child to participate in the Brown's Gymnastics program.